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    OG 2.2 Anatomy of The Female Pelvis: Og 1.8 The Cardiotocograph Class Course Obstetrics and Gynaecology Code Title Date

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    kyliever
    This document discusses the cardiotocograph (CTG), which is used to continuously monitor the fetal heart rate during labor. It provides background on the development of the CTG and notes that its use in low-risk women lacks evidence. The document outlines the pros and cons of continuous fetal monitoring, noting that it can increase cesarean and instrumental delivery rates without improving outcomes. It describes the key elements recorded in a CTG tracing and how to interpret baseline heart rate, variability, accelerations, and different types of decelerations.

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    OG 2.2 Anatomy of The Female Pelvis: Og 1.8 The Cardiotocograph Class Course Obstetrics and Gynaecology Code Title Date

    Uploaded by

    kyliever
    173 views27 pages
    This document discusses the cardiotocograph (CTG), which is used to continuously monitor the fetal heart rate during labor. It provides background on the development of the CTG and notes that its use in low-risk women lacks evidence. The document outlines the pros and cons of continuous fetal monitoring, noting that it can increase cesarean and instrumental delivery rates without improving outcomes. It describes the key elements recorded in a CTG tracing and how to interpret baseline heart rate, variability, accelerations, and different types of decelerations.

    Original Description:

    The Cardiotocograph Obstetrics and Gynaecology

    Original Title

    The Cardiotocograph CTG

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    This document discusses the cardiotocograph (CTG), which is used to continuously monitor the fetal heart rate during labor. It provides background on the development of the CTG and notes that its use in low-risk women lacks evidence. The document outlines the pros and cons of continuous fetal monitoring, noting that it can increase cesarean and instrumental delivery rates without improving outcomes. It describes the key elements recorded in a CTG tracing and how to interpret baseline heart rate, variability, accelerations, and different types of decelerations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    173 views27 pages

    OG 2.2 Anatomy of The Female Pelvis: Og 1.8 The Cardiotocograph Class Course Obstetrics and Gynaecology Code Title Date

    Uploaded by

    kyliever
    This document discusses the cardiotocograph (CTG), which is used to continuously monitor the fetal heart rate during labor. It provides background on the development of the CTG and notes that its use in low-risk women lacks evidence. The document outlines the pros and cons of continuous fetal monitoring, noting that it can increase cesarean and instrumental delivery rates without improving outcomes. It describes the key elements recorded in a CTG tracing and how to interpret baseline heart rate, variability, accelerations, and different types of decelerations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    OG 2.

    2
    Anatomy of the Female Pelvis

    OG 1.8 THE CARDIOTOCOGRAPH


    Class Senior Cycle 1
    Course Obstetrics and Gynaecology
    Code SC1 Obs
    Title CTG
    Date January 2015
    Department of Obstetrics & Gynaecology
    Department of Anatomy
    Royal College of Surgeons in Ireland
    Background of CTG
    Pioneered in 1958 by Hon.in USA and
    Hammacher in Europe
    Commercially available 1968
    Continuous monitoring of Fetal heart in
    low risk women -lacks evidence
    Needs to be viewed in conjunction with
    other assessment e.g. Fetal Blood
    Sampling and clinical situation.
    Should be used for the right reason and
    with appropriate degree of skill

    Department of Obstetrics &


    Gynaecology, RCSI
    Fetal Monitoring
    Continuous intrapartum fetal monitoring
    since the 1970s
    Low risk mothers Continuous EFM
    confers no benefit to the fetus (McDonald et al 1985)
    and increases obstetric intervention (NICE 2004,
    Mongeli at al 1997, Supplee & Vezeau 1996, Thacker et al 1995)

    Most common reason for Caesarean (CS) is


    presumed fetal compromise
    Indirect link between CS rates and
    Maternal Mortality (Hall 2001)
    Department of Obstetrics &
    Gynaecology, RCSI
    Continuous Fetal Monitoring (CFM)

    Pros Cons
    Can increases CS rate by 1.4%
    Can increase instrumental
    rate by 1.2%
    Reduction in No change in Cerebral palsy
    neonatal seizures rates
    No difference in Apgar scores
    by 0.51% Can be difficult to interpret as
    50% of Intrapartum CTGs
    have 1 abnormal feature

    Therefore CFM therefore best avoided in low risk mothers.


    Intermittent auscultation is sufficient for women identified as
    low risk

    Department of Obstetrics &


    Gynaecology, RCSI
    Interpretation of the CTG-Important
    Background information
    Antenatal CTG vrs Intrapartum CTG
    Pre- existing maternal medical conditions PIH
    etc....
    Antenatal Risk factors Rhesus Status, IUGR,
    Fetal anomaly, APH, Location of Placenta etc
    Gestational age of the fetus
    Overall progress in labour
    Drugs administered (or self administered!) to the
    mother opiates, benzodiazepines, tocolytics
    analgesia, anaesthesia, nicotine, alcohol...

    Department of Obstetrics &


    Gynaecology, RCSI
    Information recorded on the CTG
    Maternal Details, Date and Time of recording
    Maternal Pulse
    Posture of mum
    Speed of the paper ( 1cm/min 3cm/min)
    Drugs, vaginal examinations, epidural
    administration
    Following birth, the midwife should sign and
    note date, time and mode of delivery on the CTG
    The CTG should be stored securely with the
    womans notes.

    Department of Obstetrics &


    Gynaecology, RCSI
    Interpretation of CTG Basic Points

    Basic Patterns
    Baseline Heart Rate
    Variability

    Periodic Changes
    Accelerations
    Decelerations

    Department of Obstetrics &


    Gynaecology, RCSI
    Interpretation of CTG Basic Points

    CTGs can be classified as normal,


    suspicious or pathological

    Department of Obstetrics &


    Gynaecology, RCSI
    Interpretation of CTG Basic Points

    Department of Obstetrics &


    Gynaecology, RCSI
    Reassuring CTG

    Department of Obstetrics &


    Gynaecology, RCSI
    Baseline fetal Heart Rate -
    PHYSIOLOGY
    Controlled by
    (i) autonomic nervous system
    Sympathetic activity tachycardia
    Parasympathetic activity vagus nerve bradycardia
    Vagal activity is dominant Constant slowing of heart rate to 110
    160

    (ii) receptors in the aortic arch


    Chemoreceptors Acutely decreasing pO - Increased 2

    parasymathetic activity Slowing heart rate


    Prolonged hypoxia chronic changes increased sympathetic
    activity tachycardia
    Baroreceptors Hypertension increased parasympathetic activity
    Hypotension increased sympathetic activity

    Department of Obstetrics &


    Gynaecology, RCSI
    Baseline Bradycardia

    Baseline persistently below 110 bpm.

    Considerations
    Gestational age postmaturity
    increased vagal tone (90 110 bpm)
    Cord compression
    Congenital heart malformations and
    heart block
    Maternal benzodiazepines
    Department of Obstetrics &
    Gynaecology, RCSI
    Baseline Tachycardia
    Persistently high baseline >160bpm

    Considerations
    Excessive fetal movements
    Maternal stress/ anxiety catecholamines
    Gestational age ( fetus < 32 weeks vagal immaturity)
    Maternal Pyrexia
    Fetal infection Increases oxygen requirements
    Chronic hypoxia may also have decreased variability
    Fetal hormones Adrenaline and noradrenaline from
    fetal adrenals baseline tachy can be the initial
    response to fetal hypoxia
    Department of Obstetrics &
    Gynaecology, RCSI
    Variability

    5-15 beats ( not beats per minute!)


    Results from healthy interaction of all
    the physiological controls
    Good variability - intact nervous
    pathway through cerebral cortex
    midbrainvagus nervecardiac
    conduction system
    Normal / Increased / Decreased
    Department of Obstetrics &
    Gynaecology, RCSI
    Decreased Variability

    Fetal Sleep (NO LONGER THAN 40 MINS) ,


    Fluids, Position
    Drugs Pethidine in early labour (NO
    LONGER THAN 40 MINS)
    Gestational age
    SEVERE HYPOXIA autonomic nervous
    system fails to respond to stress
    Decreased variability with betamethasone
    ( not seen with dexamethasone) Senat at al BJOG
    2005

    Department of Obstetrics &


    Gynaecology, RCSI
    Grades of Variability

    Department of Obstetrics &


    Gynaecology, RCSI
    Sinusoidal Pattern
    Uncommon (0.3% of monitored labours) Young et al
    Smooth, undulating, sinewave like pattern.....beat
    to beat variability absent
    Causes
    (i) idiopathic thumbsucking, Narcotic analgesia
    (<30 mins)
    (ii)Anaemia rhesus isoimmunisation, twin to twin,
    large APH
    (iii)Severe hypoxia - especially traces with an
    amplitude of 20 beats or more or frequency of 1-2
    oscillations per minute ~ IMMEDIATE DELIVERY O
    Connor et al 1980

    Department of Obstetrics &


    Gynaecology, RCSI
    Sinusoidal Pattern

    Department of Obstetrics &


    Gynaecology, RCSI
    Accelerations

    Increase in the fetal heart rate of 15


    bpm or more for at least 15 seconds
    Either response to fetal movement
    (increased metabolic needs) or
    uterine contractions
    Reactive ( Different to variability)
    Decreased reactivity fetal sleep,
    sedation, analgesia
    Department of Obstetrics &
    Gynaecology, RCSI
    Accelerations
    Acceleration

    Early Decelerations
    Uniform in shape, occur with each contraction, appear
    as the mirror image of the contraction, onset of the
    deceleration is at the onset of the contraction, lowest
    point at the peak of the contraction, has recovered by
    end of contraction and amplitude of 40 bpm or less.
    Causes:
    Compression of fetal head and decrease in cerebral
    blood flow
    Transient hypoxia, not associated with poor
    outcome ( in labour)
    Change in maternal posture

    Department of Obstetrics &


    Gynaecology, RCSI
    Early Decelerations

    Department of Obstetrics &


    Gynaecology, RCSI
    Late Decelerations
    Late - Uniform in shape and occur after the contraction (lowest
    point occurs 15 secs after the peak of the contraction)
    Causes:
    Decreased uterine blood flow
    Abruption
    Maternal hypotension
    Excessive uterine activity
    Placental insufficiency DM, PIH, Renal Disease
    The pre-compomised fetus is at increased risk of developing
    late decels IUGR, Prematurity, Rhesus Disease, Twin to Twin
    Late Decels always associated with significant fetal hypoxia

    Department of Obstetrics &


    Gynaecology, RCSI
    Late Decelerations

    Department of Obstetrics &


    Gynaecology, RCSI
    Variable Decelerations
    Inconsistent in shape and relationship to uterine contractions
    Amplitude of 40 bpm or more
    Transient compression of the cord, nuchal cord, cord prolapse

    Department of Obstetrics &


    Gynaecology, RCSI
    Prolonged Decelerations
    Drop in FHR of 30 bpm or more for longer than 2 minutes
    Decrease in placental Oxygen transfer
    Commonly associated with preceeding variable decels.
    Total cord occlusion / prolapse
    Maternal hypotension - administration of local
    anaesthetic via epidural catheter
    Uterine hypertonia
    After VE or ARM pressure on fetal head pressure on
    vagal centre
    Important to consider the entire CTG
    Consider results of fetal blood sampling along with CTG

    Department of Obstetrics &


    Gynaecology, RCSI
    Prolonged Decelerations

    Department of Obstetrics &


    Gynaecology, RCSI

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